End of life support/questions

Hey everyone, so a little background. I’m 25 years old and I work two jobs, Cosmo is 13 now, he was 12 when he was diagnosed with Pancreatitis, Kindey Disease, and Diabetes. As a poor college kid, there’s only so much I can do for him. We decided to go with prescription food and insulin shots, we decided to forgo testing his levels since we have him fairly under control.

It’s been a whole year now since the initial diagnosis. He was doing great, we had an awesome routine in place that was working... he just recently has started to decline. He’s no longer interested in some meals (not all), he’s sleeping much longer than is normal for him, and to me his eye just look sad. He’s still peeing/pooping normally, he’s still cleaning himself normally, and he’s still just as affectionate.

My question is... how will I know when he is reaching his end of life? I don’t want to put him down earlier than necessary but I also don’t want him to be uncomfortable/in pain. To me, he’s definitely off from his usual self but I don’t know when his “time” will come.

I’m struggling and I need guidance. Thank you in advance.

 

Well, I might as well jump in the deep end on this one. On a limited income, I would not be feeding prescription food and would put that $$ to home testing. If you are not testing, how do you know that he is 'fairly under control'? How are you treating the pancreatitis? Novolin N is a pretty harsh insulin. There are other, more gentle action insulins available that work better and have longer duration for cats.

The reason for his slow decline could be one or a combination of many things. Perhaps his bg has been bouncing around - going to too low and then jumping up to compensate. Perhaps his kidney disease is progressing. Perhaps he is in chronic pain from pancreatitis. These are all just guesses, but you can see that there are several possibilities.

Generally, the 3 things that are important in managing fd are:
- home testing - in the US many people use a Relion from Walmart. Both the metre and the test strips are quite economical. BG should be tested before each shot, and when possible again in mid-cycle i.e. at about 6 hours after the morning shot.
- diet - wet, pate-style low carb foods. Fancy Feast, Whiskas, Friskies - there are many choices. It just takes a few cans usually to find the one that meets with kitty's approval. My diabetic ate Fancy Feast and my current cat sitting kitty eats Whiskas (I just bought her some food for 50 cents a can which is two servings. She gets 4 meals/day). Dry food is not good for any cat, and even worse for a diabetic - even prescription food!
- insulin - I personally prefer the longer acting insulins like Lantus or Levemir, although some cats have had good results with Prozinc.

To your actual question - Usually cats will stop eating completely and no longer wish to engage with people at all. Some cats will struggle on for a long time. There are no real rules. When you feel that the bad days outweigh the good days, then the time is probably drawing near. I wish there were a better answer to give you. There is a saying that shows up every so often in these conversations that goes like this: Better a week too early than a day too late.

Good luck

 

Have you had any of his kidney levels checked lately? He may be feeling bad from either the kidney dysfunction or a pancreatitis flare up which can be treatable. I wouldn't give up on him yet but it does sound like he is not feeling very well.

 

Is there anyone in your social circle who is diabetic who might be able to pop round with their meter so that you can do some spot-check tests for BG levels? Diabetics may be quite stable for a good period of time but something out of the blue might start affecting their BG levels adversely and numbers start to climb and regulation deteriorates. This is one potential reason why your kitty might be a bit 'off' at the moment. (Dental/gum problems and UTIs are very often the culprits; resolve those issues and regulation usually improves again.) FWIW, depression is a common clinical sign in poorly-regulated FD cats. Even a few spot checks would help you to gauge whether his BG levels are higher than normal.

The diminished interest in some feeds might be due to nausea. He has a history of pancreatitis so there is a possibility that his lethargy may be due to a flare-up in the pancreas. Try raising his food and water bowls up a few inches to see if he likes that better. Here is a useful document about nausea:

Nausea/inappetence - symptoms and treatments

If he's showing any signs of nausea when trying to eat then that can be addressed with prescription meds (e.g. GENERIC ondansetron - branded Zofran is very, very expensive but the generic should be much more affordable - available at human pharmacies with a written Rx from your vet). Get that under control and he might start feeling much brighter. A SNAP or Spec fPL test (if at all possible) could answer whether pancreatic inflammation is present, otherwise perhaps ask your vet to treat 'as if' pancreatitis is the problem. (It's impossible for me to say what's happening with Cosmo but, if it were the case that pancreatitis was at the root of his 'offness' we've seen cats here (my own included) who have been poleaxed by a flare but who make amazing recoveries when the right supportive treatments get put in place. Saoirse completely astounded me at times!) A course of B12 injections can give an under-the-weather cat with digestive system issues a major boost and anti-nausea treatment can do wonders.

Another thing I strongly recommend you try is testing your kitty's urine for ketones. See the following sticky:

Are you testing your cat for ketones?

If ketones were to be found at the root of Cosmo's 'offness' then they, too, can make a cat feel really lousy/lethargic/iffy about food but they are treatable (and treatment needs to be prompt to prevent DKA).

Also see if kidney issues/UTI might be the issue. Even a basic home urinalysis test may give you helpful info (e.g. whether there's blood / protein / glucose / ketones present; also how well/poorly urine is being concentrated (specific gravity) which may give a very rough indicator of whether kidney issues might be a factor driving the clinical signs you're observing).

Be sure to keep a close eye on Cosmo's hydration levels because dehydration can make a cat feel out of sorts (think what hangovers do to humans). The scruff will snap back into place and gums won't be sticky if a cat is well-hydrated. If dehydration is present the vet may be able to administer sub-q fluids (which can perk a cat up quite quickly) and, if regular sub-qs are needed going forward (e.g. for CKD issues) the vet may be able to teach you how to give sub-qs at home and members here should be able to give you tips on managing costs.

I hope the above isn't too overwhelming. I'm just brainstorming to try to give you suggestions of things to investigate and to discuss with your vet. Talking of which ...

The very best suggestion I can give to you is not to make any decision until Cosmo has been examined by the vet and try to get done whatever diagnostics you can manage on your funds. They will help Cosmo's body to 'speak' to you and you'll be able to make better informed choices for him.

Sending positive vibes for you both.




Mogs
.

 

I don't I want to copy this in here to make you think you should go straight to making "The Decision".

I wholeheartedly agree with all of the suggestions/possibilities listed above.

However, this might be a good time for you to start to look at some quality of life scales so that you can see where you stand now, in order to notice a change over time. Google "pet quality of life". There are bunches but I like this one:

http://vet.osu.edu/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

But most of all, you know your baby. Heck you've known him almost half your life. But I do think that there are some easy things that should be explored first.

Best,
Sandi.

Ps. It was hard for me to get through this without crying. I lost my Miss Poe to kidney disease at the age of almost 17 in May and she looks a lot like your Cosmo For her, we knew her kidney numbers had nosedived (the value in pursuing some basic tests) but she also stopped eating and her eyes told me it was time. Here's my Miss Poe:



My heart is with you and Cosmo

 

@Sandi & Whisper -

I'm so, so sad to hear about Miss Poe. Such a beautiful girl ...

My heart goes out to you, Sandi.




Mogs
.

 

Thx Mogs. Didn't mean to hijack, but the pic just hit too close to home and it bursts out when you don't expect it too.

But I did want to show that we felt more at peace with our decision by having test results in addition to our "gut feeling".

Thank you.

 

http://vet.osu.edu/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

Ty for this.

 

If his phosphorus is high from the kidney disease, that could be making him feel yucky. A binder added to his food or lower phosphorus /low carb food may help such as weruva bff in cans. Sorry your furry friend isn't feeling well. Vitamin b 12 methylcobalamin can help with appetite and energy. Also after awhile kidney disease makes them dehydrated, and sub q fluids make A HUGE difference and are not difficult or terribly expensive to do at home. It's hard to suggest his discomfort is end of life or a temporary at back sure to tweaks to his care without seeing current lab tests. Can you post a copy of his most recent labs?

 

A change in food might get Cosmo's appetite going and there is no harm in trying. You'll save a lot of money that could be better spent elsewhere. I don't know your vet but if anyone gives you grief or eye-rolling over this that's their problem. I used to think Fancy Feast was the pig-slop of cat foods but Noah's weight is stable and he almost eats on command.
Cosmo is your cat and there is truth in the saying "I see it in his eyes". But it could be something else that does not require an MRI or maxing out another credit card. Be blunt and up front with your vet. By now he or she should know you're a decent human being who has always done the right thing. I would begin with the very basic stuff like a nail bothering him or dental problems. This sounds like over simplification but sometimes we miss the smallest things.
I can't comment on internal medicine but I will on pain management. The unwillingness of human doctors to use drugs whose only purpose is to alleviate pain is a major annoyance to me. Noah is a drug addict, so what! It's too long a story for here but transdermal BUPE has made his life more than tolerable and does not affect his numbers or his ability to climb stairs or find his way in dim light.
If the time comes. Our Border Collie Hannah, the smartest of all dog breeds by far, had dementia and at the age of 12 we did the kindest thing we could for her. That was not our first time with a cat or dog. It is never easy but we have never regretted our decisions. Please promise me to keep an open mind as far as medical options and not to torture yourself with guilt.
I don't see Cosmo's avatar often but he is one sweet looking boy and I really feel for you. I hope your journey from here on is filled with peace and love.
Dickson, Noah and the boys.

 

Excellent points, and beautifully said, Dickson.

 

I would start with some simple things of changing up the food. Maybe try some forti-flora on top or parmesan cheese.


If possible maybe a vet check to see where those kidney values are and maybe see if the vet can give you some pain meds, anti nausea meds for the pancreatitis if it is a flair.

 

@shannonmarie7992 Shannon, can you keep letting us know how you and Cosmo are doing? I have been through this many times so if there's anything you want to talk about that's fine. Worried about you all day.

 

@shannonmarie7992 How are you and Cosmo? I don't mean to intrude if this is a bad time.